Splenic artery aneurysm rupture during pregnancy

Most ruptures of a splenic aneurysm occur in pregnant women, and are associated with high maternal-foetal morbidity and mortality. The typical clinical picture consists of paroxysmal pain, associated with hypovolaemic shock. The case is presented of a spontaneous rupture of a splenic aneurysm in a 37-weeks pregnant woman, with the aim of reviewing the diagnosis of this condition, since its early diagnosis is essential to reduce maternal as well as foetal mortality. In this case, the diagnosis was made after performing an urgent caesarean section, indicated due to risk of loss of foetal well-being. During the caesarean section, intense hemoperitoneum was observed. After packing and haemodynamic stabilisation of the patient, an angio-CT was performed, which confirmed the diagnosis. Splenic artery section and ligation was performed with splenectomy, after which the maternal progress was favourable. The foetal outcome was unfavourable, as it was born with a high degree of metabolic acidosis, requiring intensive resuscitation and admission to neonatal ICU. The newborn died 7 days after birth. This clinical case illustrates a typical case of a splenic aneurysm rupture, which is more frequent in the third trimester of gestation due to the haemodynamic changes that occur. The symptoms are few and non-specific until it ruptures, after which there is a hypovolaemic episode with early involvement of the uteroplacental flow that causes high foetal mortality. (C) 2018 Elsevier Espana, S.L.U. All rights reserved.